Col J P Singh
Covid-19 Pandemic (Wuhan Virus) has played merry-hell with the world by killing over three point four million men, women, young and old. April 2021 sucked India into a calamitous second wave. It is still raging. Now it is entering rural areas and taking a huge toll where there are less medical facilities and no Covid Protocol conscience. Most worrying is that in addition to elderly people the kids are getting infected. Thus the second wave is throwing newer and serious challenges and an eye opener in many ways. It can go worse. Hence with extended life span, the questions about life and death are inevitable considering the situation at hand. As a Veteran, one helplessly saw veterans, some near and dear, losing life and waiting in long line for cremation. It was pathetic to see the armed forces and military hospitals abandoning their veterans. These experiences of grief will have long term consequences in our lives. Hence there is urge to redeem better health care facilities entitled to the veterans for the services rendered and payments made at retirement.
Inevitably the sudden, unexpected and massive onslaught of the pandemic left military hospitals and Extended Contributory Health Scheme (ECHS) Polyclinics nonplussed which exposed their fragility and critical deficiencies in the much acclaimed health care systems for the veterans. Veterans saw many colleagues and friends crying/dying at the gates of military hospitals without being heard proving the myth; ‘soldiers never die, they just fade away’; wrong. One big lesson from this pandemic is ’empathy as an asset’ in the fraternity. Hence one is forced to think where does the fault and future lie. We long to be normal but it is the ‘normal’ which led to this abnormal. Therefore our thoughts must go beyond normal.
Till 2002 Veterans availed post retirement medical facilities from military hospitals (MH). Since the number of retirees increased every year and the MH infrastructure remaining constant, patient loads on military hospitals was becoming unmanageable. Thus from 01 Apr 2003, a comprehensive scheme named ECHS was put into practice. The rationale behind it was two fold. (i) to provide quality medicare to the Veterans and (ii) to relieve military hospitals of load of ex-servicemen and their dependents. Veterans inherit many diseases during the military service. Under ECHS the veteran and their dependants were entitled to the treatment in empanelled private hospitals. Conceptually, ECHS is managed by Armed Forces in order to minimise the administrative expenditure. ECHS is based upon Polyclinics for primary treatment with diagnostic facilities and for specialist and tertiary treatment upon empanelled and military hospitals. Simply stated, management of ECHS is under CDS whereas policy directions and financial sanctions come under the Department of Ex-Servicemen Welfare in MOD.
To say that this pandemic is once in a lifetime, will be making a mistake. The likelihood of the third wave of Covid-19 and newer pandemics has to be looked at. To avert the future pandemics, after this is over, we must grapple with all other possible ways for survival because the normal/status-quo failed us miserably. We have to build something better to escape other pandemics. We have no other planet to go. The solution has to be found here and now. Wef Ist January 2017 contributions for ECHS is Rs. 30,000 for OR, 60,000 for JCOs and 1,20,000 for the officers deducted on their superannuation.
Over the period, the ECHS started facing severe financial crunch. Its dependencies increased continuously and so did the billings of empanelled hospitals going up phenomenally. It soon became apparent that in the absence of 3rd party administrator, there was over-hospitalisation even for OPD cases with excessive and repeated laboratory testing for money making. Invariably at the end of a financial year, there had to be allocations from the Army’s Revenue Budget to have both ends meet, or there were carry-forward payments that effected the next year’s allocations. ECHS fell into a long drawn cycle of hand-to-mouth existence. There were many other serious hiccups like the repeated up-gradation of ECHS Cards, strictures in audit reports, inadequacy of medicines in dispensaries, denial of treatment by empanelled hospitals, delay in clearance of dues and demand for advance deposits for treatment. Thus it becomes obligatory to learn from the past and most importantly from the alarming present health crisis and offer opinions for the future. At these times of gloom, one is reminded of Bishop Desmond Tutu saying, “the Hope is being able to see that there is light despite all of the darkness.”
By now ECHS dependency has grown to over fifty six lakhs (veteran 18 lakh and dependents 38 lakh) and is increasing by three lakh annually. There are 410 polyclinics and 2200 empanelled hospitals in India. ECHS annual budget has gone to Rs. 3,500 crore. To tide over the recurring problems creation of ‘Veteran Hospitals’ at select stations is under consideration since 2016.
During the initial fallout of Covid-19 empanelled hospitals refused to admit ECHS patients, apparently for pecuniary interests. ECHS Polyclinics were stretched to their maximum while they had little role in treatment for Covid-19 except referrals to empanelled hospitals/testing laboratories. Responses from the latter were disappointing because of monetary interests. ECHS pays on govt rates, while their own rates were about Rs 1 lakh per night in an oxygenated bed, and much more for an ICU bed. Many hospitals asked ECHS patients to cater for own oxygen and drugs if at all they were admitted. The Veterans had to shuttle between ‘pillar-to-post’ for vaccination too. On top of that second wave came as a blow on the public health system including private hospitals and all became proverbial ‘chock-a-block full’. As elsewhere in health care management, ECHS higher ups also turned unresponsive, at times to the grave detriment of veterans.
Military hospital of all types are meant for the serving soldiers. There is approximately 35,000 in-patient bed capacity in them. Responding to the current calamitous situation, military hospitals finally rose to the occasion. Additional Covid and Oxygen beds have been created in each. Despite various gagging issues, veterans are undoubtedly most comfortable with military hospitals. With empanelled hospitals raising their hands and service hospitals pushed to the maximum and Polyclinics feebly functional, veterans are not only facing the wrath of Covid-19 but of the routine treatment as well. Many precious lives are lost continuously because of lack of proper treatment. It is essential to offset the excessive reliance on empanelled/military hospitals by ‘Veteran Hospitals’.
In 2016 an exclusive ‘Cardiology and Dental Centre’ were created in Army Hospital (R&R) Delhi for the Veterans. This was to facilitate secondary and tertiary treatment in the fields of cardio and dental. Taking the initiative forward, such exclusive care centre should have been created in high-pressure military stations and named ‘Veteran Hospital’ with various specialties and requisite beds in (i) emergency ward, (II) dialysis ward and (iii) day care/observation ward.
Revitalization of medicare is going on countrywide. It is imperative to have Veterans Hospitals in the large city centres where large number of veterans live. Population of veterans in Jammu district is over 70,000 excluding dependents. ECHS Satwari’s daily sick report is around 1000. It has 11 specialists/doctors. (Despite Corona restrictions March 2021 sick report is 12,600). 9 hospitals are empanelled in Jammu. Thus Jammu is ideal station for Veterans Hospital. Within Satwari Cantonment there is G B Pant Cantonment Hospital run by Cantonment Board whose Chairman is the Station Commander/Dy GOC. It has 8 doctors/specialists and enough infrastructure as per the newspapers report. Instead of creating a new Veteran Hospital, grossly underutilized and ideally located G B Pant Hospital can be appropriated. Large number of military super-specialists, doctors and para-medicos who superannuate annually can be re-employed for it. If yearly recurring costs of the ECHS and payments to empanelled hospitals are computed, Veteran Hospitals will be advantageous in the long run. Even if 10 such hospitals are taken forward in a phased programme country wide, nearly 75% of Veterans will be taken care of.
In sum, the immense problems created by empanelled hospitals most especially during pandemic will be obviated by having Veterans Hospitals. Veterans will be in comfortable environs created by superannuated military medicos. With the benefit of hindsight, the transformation of ECHS is mandatory. Without losing more time appropriation of G B Pant Hospital Satwari be started under the aegis of the army for which retired Generals contribution is solicited.
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